Discoloration after Regenerative Endodontic Procedures: A Critical Review.

Discoloration remains an unfavourable complication of otherwise successful regenerative endodontic procedure of immature teeth with necrotic pulp. This review presents a critical view on current knowledge of discoloration sources, its treatment and possible preventive modalities, dealing mainly with the use of antibiotics, ethylendiaminotetraacetic acid, calcium hydroxide, mineral trioxide aggregate, calcium silicate cements, sodium hypochlorite and chlorhexidin during regenerative treatment and their possible interactions. Bleaching as a discoloration treatment modality is discussed as well.

In Vitro Mechanical Properties of Mineral Trioxide Aggregate in Moist and Dry Intracanal Environments.

INTRODUCTION: The purpose of this study was to examine the microhardness and modulus of elasticity (MOE) of White ProRoot MTA (Dentsply Tulsa Dental, Tulsa, OK) after setting in moist or dry intracanal conditions. METHODS AND MATERIALS: To simulate root canal system, 14 polyethylen molds with internal diameter of 1 mm and height of 12 mm were used. These molds were filled with 9-mm thick layers of White ProRoot Mineral Trioxide Aggregate (MTA; Dentsply Tulsa Dental, Tulsa, OK). The experimental group (n=7) had a damp cotton pellet with 1.5 mm height and a 1.5 mm layer of resin composite placed on it. In control group (n=7) the whole 3 mm above MTA were filled with resin composite. The specimens were kept in 37°C and relative humidity of 80% for 4 days in order to simulate physiological conditions. Specimens were longitudinally sectioned and nanoindentation tests were carried out using Berkovich indenter at loading rate of 2 mN/s at 4×5 matrices of indents which were located in the coronal, middle and apical thirds of the specimen's cross section, to evaluate the microhardness and modulus of elasticity of the specimen to appraise the progression of the setting process. Differences were assessed using nonparametric generalized Friedman rank sum and Wilcoxon Rank-Sum tests. RESULTS: Statistical analysis showed that there was a significant difference in microhardness and MOE between control and experimental groups at coronal (P<0.001), middle (P<0.001) and apical (P<0.001) thirds of the simulated rod from simulated apical foramen. Kruskal-Wallis test showed no significant effect of depth on microhardness of material in experimental or control groups. CONCLUSION: Within limitations of this in vitro study, it seems that moist intracanal environment improves setting of MTA in various depths.

Marginal integrity of low-shrinking versus methacrylate-based composite: effect of different one-step self-etch adhesives.

The aim of the study was to evaluate the influence of composite type and adhesive system on the quality of marginal adaptation in standardized Class V cavities before and after thermo-mechanical loading (TML). The cavities were restored using different combinations of three adhesive systems [(Silorane System Adhesive (SSA), Clearfil S3 Bond (S3), G-Bond (G-B)] and two resin composite materials (Filtek Silorane, Clearfil AP-X). Six groups (n = 10): Group A (SSA-Primer + SSA-Bond, Filtek Silorane), Group B (SSA-Primer + SSA-Bond, Clearfil AP-X), Group C (S3 + SSA-Bond, Filtek Silorane), Group D (S3 + SSA-Bond, Clearfil AP-X), Group E (G-B + SSA-Bond, Filtek Silorane) and Group F (G-B + SSA-Bond, Clearfil AP-X) were defined. Marginal adaptation was assessed on replicas in the SEM at 200 × magnification before and after TML (3000 × 5-55 °C, 1.2 106 × 49 N; 1.7 Hz) under simulated dentinal fluid. The highest scores of continuous margins (%CM) were observed in the group F (G-B + SSA-Bond, Clearfil AP-X: before loading 96.4 (±3.2)/after loading 90.8 (±7.0)). A significant effect of adhesive system, composite type and loading interval was observed on the results (p < 0.05). Significantly lower scores of %CM were observed for silorane-based composite (Filtek Silorane) after TML in comparison with methacrylate-based composite (Clearfil AP-X) considering total marginal length (p < 0.05). For both Filtek Silorane and Clearfil AP-X, G-Bond performed significantly better than SSA-Primer and Clearfil S3 Bond (p < 0.05). For all combinations of one-step self-etch adhesives and SSA-Bond resin coating, silorane-based low-shrinking composite exhibited inferior marginal adaptation than did the methacrylate-based composite.

Silorane, ormocer, methacrylate and compomer long-term staining susceptibility using ΔE and ΔE 00 colour-difference formulas.

The aim of this study was to evaluate the staining susceptibility of a silorane (Filtek Silorane), an ormocer (Ceram X Duo), a methacrylate (Tetric EvoCeram) and a compomer (Dyract) exposed on the long term to various staining agents by using ΔE and ΔE 00 colour-difference formulas. Thirty-six disc-shaped specimens were made of each of the four chemically different materials, randomly divided in six groups (n = 6) and immersed in five staining solutions (red wine, juice, coke, tea and coffee) or stored dry (control) in an incubator at 37 °C for 99 days. Spectrophotometric measurements by means of a spectrophotometer (Spectroshade Handy Dental, MHT) were repeated over a white (L* = 92.6, a* = -1.2, b* = 2.9) and black (L* = 1.6, a* = 1.2, b* = -1.0) background made of plasticized paper, in order to determine the colour changes according to ΔE, ΔE 00 and translucency formulas. Statistical analysis was performed by means of factorial Anova, Fisher's LSD test (post hoc) and a Spearman rank correlation between ΔE and ΔE 00. When analysed over a white background, mean ΔE 00 values were highly significantly different and varied from 0.8 (Ceram X Duo/air) to 20.9 (Ceram X Duo/red wine). When analysed over a black background, mean ΔE 00 values were highly significantly different and varied from 1.0 (Ceram X Duo and Tetric/air) to 25.2 (Ceram X Duo/red wine). Differences in translucency varied from 0.3 (Ceram X Duo/air) to 21.1 (Ceram X Duo/juice). The correlation between ΔE and ΔE 00 over a white background was 0.9928, while over a black background, it was 0.9886.

Microhardness of light- and dual-polymerizable luting resins polymerized through 7.5-mm-thick endocrowns.

STATEMENT OF THE PROBLEM: The complete polymerization of luting resins through thick indirect restorations is still questioned. PURPOSE: The purpose of this study was to evaluate the degree of polymerization of light- and dual-polymerizable luting resins under thick indirect composite resin and ceramic endocrowns by means of Vickers microhardness measurements. MATERIAL AND METHODS: The Vickers microhardness measurements of a light-polymerizable microhybrid composite resin and a dual-polymerizable luting cement directly polymerized in a natural tooth mold for 40 seconds with a high-power light-emitting diode lamp (control) were compared with measurements after indirect irradiation through 7.5-mm-thick composite resin and ceramic endocrowns for 3 × 90 seconds. A test-to-control microhardness values ratio of 0.80 at a depth of 0.5 mm below the surface was assumed as the criterion for adequate conversion. RESULTS: For the Vickers microhardness measurements of a dual-polymerizable luting cement, no differences (P>.05) were found between Vickers microhardness control values and values reported after polymerization through composite resin and ceramic endocrowns. For The Vickers microhardness measurements (±SD) of a light-polymerizable microhybrid composite resin, control values were significantly (P<.05) higher (111 ±3.3) than those reported after polymerization through composite resin (100.5 ±3.8) and ceramic (99.7 ±2.3) endocrowns. However, the hardness values of The Vickers microhardness measurements of a light-polymerizable microhybrid composite resin polymerized through the endocrowns were approximately 10% to 12% lower than those of the control values. Two-way ANOVA showed the influence of the luting material on the Vickers microhardness values (P<.05). The effect of endocrown material was not significant (P>.05). CONCLUSIONS: Under the conditions of this in vitro study, Vickers microhardness values of the dual-polymerizable resin cement and the light-polymerizable restorative composite resin irradiated for 3 × 90 seconds with a high irradiance light-emitting diode lamp through 7.5-mm-thick endocrowns reached at least 80% of the control Vickers microhardness values, which means that both materials can be adequately polymerized when they are used for luting thick indirect restorations.

Effect of different bonding strategies on the marginal adaptation of class 1 silorane restorations.

PURPOSE: To evaluate the quality of marginal and internal adaptation of Filtek Silorane composite in standardized class 1 cavities before and after thermo-mechanical loading using different application protocols of the Silorane System Adhesive (SSA). METHODS: Five groups (n = 10) of class 1 cavities were restored with Filtek Silorane using different SSA applications. Total bonding (TB): Group A (SSA), Group B (SSA without primer polymerization), Group C (enamel etching + SSA), Group D (enamel etching + SSA without primer polymerization) and Selective bonding (SB): Group E. Marginal adaptation was assessed on replicas in the SEM at x200 magnification before and after thermomechanical loading (3,000 x 5-55 degrees C, 1.2.10(6) x 49N; 1.7Hz) under simulated dentin fluid. After loading, the samples were sectioned and the internal adaptation was evaluated as well. RESULTS: The lowest scores of %CM (Continuous Margin) before/after thermo-mechanical loading being 80.8 (+/- 8.2) / 32.1 (+/- 8.3) were observed in the control group A. Enamel phosphoric acid etching prior to the application of the SSA resulted in significantly higher %CM before and after loading in comparison with the "non-etched" groups (P > 0.05). When enamel etching was performed before the application of the adhesive system, no statistically significant differences (P > 0.05) were observed regardless of how the SSA was applied (total vs. selective bonding). Internal adaptation was negatively influenced by omitting the SSA-primer polymerization (P > 0.05).

Shrinkage kinetics of a methacrylate- and a silorane-based resin composite: effect on marginal integrity.

PURPOSE: To evaluate the relation between the linear displacement (LD), shrinkage force (SF) and marginal adaptation of a methacrylate- and a silorane-based composite. MATERIALS AND METHODS: The LD and SF of 8 samples made of Filtek Supreme XT (methacrylate-based composite) and Filtek Silorane (silorane-based composite) were measured for 180 s from the start of polymerization. Large bulk-filled Class I cavities were restored with both resin composites, and two C-factors were simulated by applying the same adhesive system in different ways: the Silorane System Adhesive (SSA) was applied on enamel and dentin (C-factor 3.5) or only on enamel margins (C-factor of 0.4). Percentages of continuous margins (%CM) were quantitatively assessed with SEM before and after simultaneously loading with 1.2 million mechanical occlusal cycles (49 N; 1.7 Hz) and 3000 thermal cycles (5°C to 50°C) under dentinal fluid simulation. RESULTS: Significantly lower scores of LD and SF were observed for Filtek Silorane (LD: 12.0 µm ± 1.3, SF: 13.7 N ± 1.0) than for Filtek Supreme XT (LD: 25.0 µm ± 0.6, SF: 36.3 N ± 2.9). Both variables, ie, composite type and C-factor, had a significant effect on marginal adaptation (p < 0.05). In the groups with high C-factor (SSA was applied on the entire cavity surface) percent of continuous margin (%CM) (mean ± SD) before and after loading, respectively, was 24.4 ± 16.6 and 2.1 ± 2.4 for Filtek Supreme XT, and 58.8 ± 9.9 and 35.4 ± 4.1 for Filtek Silorane. When adhesion was confined to enamel margins (lower C-factor), %CM before and after loading, respectively, increased to 76.1 ± 9.6 and 64.2 ± 11.5 for Filtek Supreme XT, and 96.6 ± 1.7 and 94.2 ± 2.1 for Filtek Silorane. CONCLUSIONS: The silorane-based composite exhibited significantly lower shrinkage forces and better marginal adaptation than did the methacrylate-based composite.

Supragingival relocation of subgingivally located margins for adhesive inlays/onlays with different materials.

PURPOSE: This study evaluated the marginal adaptation of supragingivally relocated cervical margins. Newly developed and reference materials were compared. MATERIALS AND METHODS: Eighty-eight extracted human teeth were divided into 11 groups. A standardized boxshaped cavity (4.0 mm mesiodistal width, 1.5 mm axial depth) was prepared on each tooth with the cervical margin 1.3 mm below the cementoenamel junction. Seven different restorative materials (Filtek Silorane [Sil], Clearfil AP-X [APX], Clearfil Majesty Posterior [CMP], Clearfil Majesty Flow [CMFlow], RelyX Unicem [RelyX], SDR [SDR], Vertise Flow [VertFlow]) were applied in a layer of 1.5 mm, combined with different adhesive systems (Filtek Silorane Primer + Bond [SilPB], Clearfil Profect Bond [ClePB], Filtek Silorane Bond [SilB]). No indirect restorations (ie, inlays/onlays) were placed on these restorations. SEM analysis was performed to evaluate marginal adaptation in enamel and dentin. The results were subjected to statistical analysis by Kruskal Wallis and Duncan post-hoc tests. RESULTS: In both dentin and enamel, statistically significant differences were present between groups (p < 0.001). In enamel, the lowest percentage of continuous margin was observed for SilPB/CMP, SilPB/APX, and ClePB/SDR, while SilPB/Sil exhibited the highest percentage of continuous margin, although this was not statistically different from other groups except for SilPB/CMP, SilPB/APX, and ClePB/SDR. In dentin, a higher percentage of continuous margin was observed for all materials than in enamel (p < 0.002). Statistically significant differences were found between ClePB/SilB/Sil, ClePB/SDR, and RelyX, SilPB/APX, ClePB/APX, and ClePB/Sil. ClePB/Sil showed the lowest marginal adaptation. Considering the overall marginal length, the best marginal adaptation was exhibited by ClePB/SilB/Sil, followed by SilPB/Sil, ClePB/SDR, and ClePB/CMP. CONCLUSION: Marginal adaptation of supragingivally relocated cervical margins is significantly influenced by the materials used.

In vitro evaluation of marginal and internal adaptation after occlusal stressing of indirect class II composite restorations with different resinous bases and interface treatments. "Post-fatigue adaptation of indirect composite restorations".

The present study evaluated the influence of different composite bases and surface treatments on marginal and internal adaptation of class II indirect composite restorations, after simulated occlusal loading. Thirty-two class II inlay cavities were prepared on human third molars, with margins located in cementum. A 1-mm composite base extending up to the cervical margins was applied on all dentin surfaces in the experimental groups; impressions were made and composite inlays fabricated. The following experimental conditions were tested: no liner (control group), flowable composite treated with soft air abrasion (experiment 1), flowable composite sandblasted (experiment 2) and restorative composite sandblasted (experiment 3). All specimens were submitted to 1,000,000 cycles with a 100-N eccentric load. Tooth-restoration margins were analysed semi-quantitatively by scanning electron microscopy before and after loading; internal adaptation was also evaluated after test completion. The percentage of perfect adaptation in enamel was 79.5% to 92.7% before loading and 73.3% to 81.9% after loading. Perfect adaptation to dentin was reduced before loading (54.8% to 77.6%) and after loading (41.9% to 63%), but no difference was found among groups for pre- and post-loading conditions. No debonding occurred between the base and composite luting. A significant, negative influence of cyclic loading was observed. The results of the present study support the use of flowable or restorative composites as base/liner underneath large class II restorations. Soft air abrasion represents a potential alternative to airborne particle abrasion for treating cavities before cementation. The application of a composite base underneath indirect composite restorations represents a feasible non-invasive alternative to surgical crown lengthening to relocate cavity margins from an intra-crevicular to supra-gingival position.

Marginal seal stability of one bottle adhesives in Class V vs. Class I cavities.

The aim of this study was to test the influence of two different cavity configurations on marginal stability of recent one bottle "etch & rinse" and "self-etch" adhesives in Class V vs. Class I cavities, before and after thermo-mechanical loading under simulation of dentinal fluid. Forty human upper molars were selected and assigned to five experimental groups. Intrapulpal pressure was maintained during cavity preparation, restoration placement, finishing and stressing. Standardized Class I and V-Shaped Class V cavities were prepared on each tooth. Half of the margins of Class V cavities were located in enamel and half in dentin. All cavities were restored with different adhesives systems and a nano-hybrid composite. Materials were light-cured using a LED unit. Restored teeth were loaded in a computer-controlled chewing machine with 1.2 million mechanical occlusal cycles simultaneously with 3,000 thermal cycles (5-50-5°C). Impressions were made with polyvinylsiloxane of each restoration before and after loading. Gold-coated epoxy replicas were prepared for SEM examination at ×200 magnification. Significant differences between materials were found both before and after loading (Kruskal-Wallis, Bonferroni, p < 0.05). Significant differences were also found between Class I and V restorations (Wilcoxon Matched-Pairs Signed-Rank Test, p < 0.05). Even before thermo-mechanical loading, none of the groups had 100% continuous margin. Marginal seal stability of recent one bottle "etch & rinse" and "self-etch" adhesives are significantly different and susceptible to cavity configuration.

Accuracy of electronic apex locater-controlled handpieces.

An in vitro model was used to test a hypothesis that the manual (apex locator) and motor-driven (apex locator-controlled handpiece) operating modes of 3 newly developed apex-locator-controlled handpiece devices (Dentaport ZX, Endomaster, XSmart Dual) give the same working length. The depth of penetration of the file into the root canal was measured using a digital micrometer and the distance of the tip of the file relative to the major root foramen was determined by scanning electron microscopy (SEM). In the manual mode, the XSmart Dual device reported significantly shorter working lengths than the Dentaport ZX or the Endomaster devices. In the motor-driven mode, the XSmart Dual device reported significantly longer working lengths than the Dentaport ZX but not the Endomaster. Most instruments driven by the handpieces were confined within the root canal and differences in working lengths between manual and motor-driven modes were small for all devices (tenths of millimeters). We concluded that although the motor-driven mode of these devices appeared to be clinically safe, measurements obtained in manual and motor-driven operating modes are not equivalent.